• Ozzie Paez

Future Emergencies – a story


George had been traveling for two days after leaving Denver to join his granddaughter, Gail, in Denbigh, Wales. She was working in a nearby archeological dig as part of a year of study at Oxford, and he was counting on enjoying a few adventures in her company. The flight to London had gone well, though he was feeling more tired than usual; must be the stress and excitement of the trip, he thought. The personal activity and health monitor he wore on his wrist each day had been registering minor changes in skin temperature, heartrate, respiration and body chemistry, but all were within set limits.

His physiological monitoring had been increased by his doctor due to the trip and pre-existing heart conditions. More detailed physiological data was being collected with increased frequency, and analyzed in near real-time. The results were sent to George and his cardiologists, but it was just precautionary. Still, he felt reassured in the knowledge that he was connected to his doctors and health support team even during international travel.

The adventure unfolds

George sets off from Heathrow on the 230-mile journey to Denbigh via the M41, taking breaks along the way for food and local explorations. Eight hours later, as he approaches Denbigh, he suddenly feels lightheaded. His monitors note the change and attempt to stimulate him back to full awareness. It’s too late. The car swerves and hits an on-coming vehicle carrying a family of four; it’s 7:45:27 PM, local time. The impact, registered by accelerometers in both vehicles and wearable monitors, triggers immediate notifications to local emergency services (7:46:12). Two ambulances and law enforcement officers are quickly dispatched to the site (7:48:05), with an estimated arrival time of four minutes.

In the meantime, George’s monitoring system responds to the impact by changing his monitoring status to Critical. Streams of enhanced physiological data begin flowing to cloud servers, where powerful algorithms start analyzing them in real-time. In the other car, a 28-year-old mother and her two kids (5 and 7) are also wearing monitors; the father (31) had left his behind. Their monitoring systems also change their status to Critical and start transmitting and analyzing enhanced physiological data streams. These show that the mother and younger child are stable and doing well, while the older sibling is demonstrating signs of physical distress and anxiety. The father’s presence is noted by car sensors, but no real-time physiological data is yet available (7:50:17).

Data and analysis from the accident victims are automatically made available to paramedics and emergency room personnel at the designated nearby hospital (7:51:00). As paramedics rush to the scene (7:51:20), emergency room staff begin evaluating the victims’ physiological status, while preparing to support the on-site paramedics and arranging to receive the injured (7:51:42). EMS ambulances arrive on scene (7:50:23) and paramedics begin evaluating the victims’ injuries (7:52:05). They quickly connect the unmonitored man to their mobile emergency monitoring systems and start transmitting his physiological data to the emergency room (7:55:25). All victims are quickly stabilized and transported to the hospital (8:09:38).

Meanwhile, it’s almost three in the morning in Denver, when George’s monitoring system notifies his cardiologist and primary care physician, Dr. Judy Powell, that one of her patients has suffered a health emergency. She quickly logs onto her medical services portal, and learns that George has had an apparent cardiac episode and car accident, while traveling abroad. She examines the data from his monitor and realizes that the cardiac event had preceded the crash, and may have caused her patient to lose control of his vehicle. She calls the contact number for the British hospital’s emergency room, which is displayed on her screen, explains who she is and offers to provide additional insights into George’s health conditions and history (8:05.37PM Denbigh/3:05:07AM Denver). She has a short conversation with the emergency room doctor, explains that George’s cardiac incident had preceded the crash and conveys his negative reactions to various medications (8:10.05PM Denbigh /3:10:05AM Denver).

By the time the ambulances arrive at the hospital (8:10:00AM), the emergency room team has been fully briefed on the incoming patients’ conditions. They are armed with a wealth of monitoring data and algorithmic analysis that, for three of the four incoming patients, begin a few minutes before the accident. They also have medical records available for all of the patients, including the tourist from Colorado. A supporting team consisting of a cardiologist, orthopedic surgeon and pediatrician are briefed and provided with access to patient status and health information. They will be on standby and ready to support the emergency team should conditions demand (8:15:52). Welcome to the future of personal monitoring, emergency incident identification and response!

Background and implications

The technologies in the story are already available and more will be entering the market in the years ahead. They will soon empower medical services to respond to emergencies in a fraction of the time it takes today. Yet reducing the time from incident to hospital emergency room is only part of the story. The information captured and analyzed by emerging personal monitoring technologies will enable emergency room teams to support paramedics in delivering more effective treatment on site and during transport. Emergency teams will have detailed information about incoming patients, their medical histories and physiological conditions at the accident site and during transport. This accelerated process will deliver more comprehensive lifesaving treatments sooner than ever before, giving victims a better chance to survive and fully recover.

Dr. R. Adams Cowley is considered was a pioneer in the treatment of shock trauma. He coined the term "Golden Hour" to stress the importance of quickly getting trauma victims to emergency care.

In the 1960s, Dr. Adams Cowley of Baltimore’s University of Maryland Medical Center introduced the concept of the “Golden Hour” in cases of trauma. His experiences in post-World War II Europe and later in Baltimore suggested that patient survival and recovery improved significantly when treatment was quickly administered after an injury.[1] His ideas had been validated through a US Army funded study he lead on how victims responded to trauma-induced shock. The results changed emergency response standards and solidified the concept of the Golden Hour, which remains influential sixty years later.

While some recent studies have challenged the Golden Hour principle, EMS guidelines continue to stress preparing and getting trauma patients to emergency rooms as soon as possible. Charlie Eisele, an editorial board member of the Journal of Emergency Medical Services, flight operations supervisor and flight paramedic for the Maryland State Police points out that the Emergency Medical Services job is defined by three phases: “1) get to the patient quickly, 2) fix what we can fix and 3) quickly get the patient to the right hospital. Anything we can do to compress each of these time periods is good for the patient. We’ve known this in the traumatically injured, and now we use it for STEMI (heart attacks) and stroke patients; more are sure to follow.”[2]

Emerging technologies will soon radically compress the time from incident to response. Sensors in advanced wearable monitors already measure vital signs, i.e. skin temperature, heart rate, respiration rate and blood pressure, plus additional cardiovascular, physical activity and energy expenditure[3]. Other sensors that measure electrodermal (skin) activity are already being tested and tuned to detect seizures and abnormal brain activity. Machine learning systems are currently being used to process sensor data and create models that can recognize specific brain events, even mood changes[4]. As a result, next generation wrist monitors will detect impending life-threatening events such as heart attacks and strokes, and notify patients, their personal physicians and emergency services. This automated process will significantly compress the time between onset of symptoms and emergency medical treatment[5]. The benefits will be measured in lives saved, faster patient recovery and lower medical costs.

The Wavelet monitoring system was designed for clinical research. Its wrist activity and physiological monitor is the most advanced device of its kind currently available.

There are barriers to fully exploiting personal monitoring technologies and to integrating emergency notification and response. Most are due to obsolete regulations and reasonable concerns over privacy and information security threats. These will have to be addressed by legislators and regulatory agencies. New protocols, training and process changes will be needed so smart systems can decide when, what and how much health information to share with emergency responders. Sharing information across national borders will likely require international agreements to ensure compliance with privacy and liability laws.

Governments could also help by sponsoring the development and initial testing of systems and concepts, as was done in the mapping of the human genome. It means investing, establishing standards and developing limited regulatory frameworks. The private sector and academia have already compiled an astounding record of developing, bringing to market and improving wearable monitoring technologies, so there is already an existing infrastructure on which to build. With cooperation between the private sector, academia and governments, practical deployments of these systems could begin in three years or less.

References

[1] Tribute to R Adams Cowley, MD, University of Maryland Medical Center, accessed July 17, 2017, http://www.umm.edu/programs/shock-trauma/about/history

[2] Charlie Eisele, The Golden Hour, August 31, 2008, Journal of Emergency Medical Services, http://www.jems.com/articles/2008/08/golden-hour.html

[3] Wavelet Health, products, https://wavelethealth.com/products/

[4] Wearable devices communicate vital brain activity information, Medical Product Outsourcing Magazine, accessed July 31, 2017, http://www.mpo-mag.com/contents/view_breaking-news/2017-05-22/wearable-devices-communicate-vital-brain-activity-information/7963

[5] Jennie Dusheck, Wearable biosensors may help detect illness prior to symptoms, January 16, 2017, Medical Product Outsourcing Magazine, http://www.mpo-mag.com/contents/view_breaking-news/2017-01-16/wearable-biosensors-may-help-detect-onset-of-disease/

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